Summary – Day 1

For Summaries on the Plenary Session

For Summaries on Day 2 Breakout Sessions

Day 1 – Noon Sessions

BDA Specialist NAGE Group – Diversity of age with NAGE.
Gillian Miller, NAGE Committee Member and Specialist Dietitian at North West Rehab Service, Glasgow and Nicola Howle, NAGE Committee Member

Age is used as a label and most of us have preconceived ideas of old age which commonly includes ill health, poverty, isolation, malnutrition, incapacity, and dependence. Yet there are rising numbers of older people who are in good health, fit and active, working (in paid and voluntary capacities), of healthy weight and living independently. There are also rising numbers of older people from differing ethnic groups. The elderly are a more diverse group than is popularly assumed. Services for older people however, are usually based on the stereotype of old age. This session challenged us to think again about older people, in order to shape services that meet adequately meet their real rather than assumed needs.

Claire Holmes, BDA Council Member, Northern Ireland Constituency Member

 

Oncology Special Interest Session – Optimum diet and exercise strategies to prevent breast cancer and its recurrence
Dr Michelle Harvie SRD PhD, Lead Dietitian for Cancer Prevention, Genesis Breast Cancer Prevention Centre, University of South Manchester

Details to follow

 

Abbott Nutrition Supported Session – Managing GI symptoms in the community
Kelly McCabe, Head of Dietetics and Therapies at LOC (Leaders in Oncology Care) London

The session focused on the management of symptoms of GI intolerance in malnourished adults in the community with particular reference to identifying them, highlighting the difficulties they face and to discuss the rationale for developing a consensus guide, which was presented as part of the session Kelly focused on the need for prompt intervention, not least to improve the quality of life for patients but also to improve the quality of treatment.

Data shows that 8.5% of patients prescribed ONS reported a GI symptom in the preceding 14 days (from longitudinal GP database)

A cycle of malnutrition was presented that could be exacerbated by nutritional intake, with the type of ONS used being a possible factor in this.

In a study of Dietitians over three quarters (78%) of respondents felt that there is currently insufficient guidance on managing the symptoms of GI intolerance, available for health care professionals and that more is needed.

Kelly went onto present an algorithm which focused on the potential use of a peptide based feed in managing symptoms as part of a systematic approach to treatment. The use of such an algorithm would have to be carefully implemented, to ensure timely intervention and a clear MDT approach would be required to do this.

Steven Grayston, BDA Council Member, Chair of Professional Practice Board


belVita Lunch Breakout

Belinda Quick has a PhD in Food Biosciences, focusing on prebiotics, and an MSc in Public Health Nutrition.

Belinda took the delegates through the several clinical studies behind the science of their product. Isotopic clinical studies (Vinoy et al, 2013; Peronnet et al, Submitted; Nazarre et al, 2010) show that slowly digestible starch, which represents 35% to 53% of available starch in belVita biscuits, leads to a more moderate and stable appearance of exogenous glucose throughout the morning, described Belinda.

A questioner asked ‘How do you explain the starch versus sugar content’ of the product. Belinda explained that the sugar content was quite moderate, in relation to other breakfast options, and works well within a balanced breakfast.

“Over 15 years of research and a lot of energy and development has gone into this product” stated Belinda. This has resulted in the validated wording that now appears on their product.

Karen Ellis, BDA Council Member, Dietetic Support Worker Member


Day 1 – 2pm Sessions

BDA Specialist Freelance Dietitians – Strategies for getting your services commissioned.
Jennifer Smith, BSc Nutrition and Dietetics MSc Weight Management, Public Health Lead

Jenn Smith, a dietitian and Public Health Lead, presented an informative and useful session entitled ‘Strategies to get your services commissioned’. This gave a guide to the commissioning process in the new NHS, opportunities and how to go about successfully bidding. Examples for dietitians included:

Weight management, Training, NHS Health Check Programme, Nutrition for older adults (especially malnutrition), Clinics – groups vs individuals, Programme development, Report writing, Adult social care, Children services, Community projects, Partnerships with Clinical and psychological experts (bidding as a group will strengthen your bid)

Interestingly Jenn suggested the Freelance Dietitians Group could establish an FDG bidding framework and/or bid on behalf of members.

Sian Porter, BDA Council Member, Chair of Communications and Marketing Board

 

BDA Specialist Mental Health Group – How does patient self-management for chronic disease, translate into practice for people with mental health and learning disabilities?
Elaine Jennings, BSc (Hons); PGDip Dietetics; PGCE. Special Mental Health Diabetes Clinical Lead Dietitian, Betsi Cadwaladr University Health Board and Member of the Mental Health Group

The presentation provided information on the statistics of diet/eating patterns/activity and evidence.  In this group of population there is higher incidence of poor diet and poorer health assessment for example fewer than 30% of people with schizophrenia are given an annual health check and patients gain an average of 13lbs in the first 2 months of commencing antipsychotic medications.   Up to 55% may never have their weight monitored.

The presentation outlined some of the mental conditions which may hamper compliance and affect mortality. Self management may therefore not always be effective.   Prompt diagnosis and treatments are essential to ensure improved outcomes.    This is a challenging field to work in and organisations such as rethink (www.rethink.org or Mencap) offer help/advice and support.  Dietitians have to work on raising the awareness of the health needs and poor outcomes for people who have a mental illness.

An excellent presentation which increased awareness of the health needs for this group of patients.

Marjory MacLeod, BDA Council, Chair of BDA Scottish Board

BDA Specialist DMEG Group – Tailoring care plans according to ethnicity
Dr Louise Goff, Lecturer in Nutritional Sciences, King’s College London, Division of Diabetes and Nutritional Sciences

This session had a major interest in the health inequalities in ethnic minority groups. The highest prevalence of diabetes is found in ethnic backgrounds predominantly Indian, Pakistani & Bangladeshi. Due to the diabetes prevalence in ethnic minority groups there is also a lower bmi cut off points to assess risk factors to diabetes.

The main reasons for understand why there are such high predominance of diabetes in these groups is due to economic, cultural, diet and physical activity factors. There is a higher rate of unemployment and financial burden amongst these groups which leads to food insecurity and reliance on energy dense foods and also prevent physical activity participation due to cost. Other reasons are due to cultural foods and cooking styles for these groups and also in the healthcare environment that healthcare provides lack cultural understanding and awareness.

To combat this culturally tailored diabetes education programmes have shown their effectiveness and improvements in knowledge, self help behaviours and HbA1c levels. Culturally sensitive healthcare improves diabetes outcomes and is key to addressing health inequalities.

Ravi Nagar, BDA Council Member, Student Representative


Day 1 – 3pm Sessions

Nutricia Advanced Medical Nutrition Supported Session Gastroenterology
Supporting Dietitian’s in managing Crohn’s with a scientific basis.
Professor John Hunter and Nina Powell

Details to follow

 

BDA Specialist Group – Renal Nutrition Group – CKD – a problem for all of us
Jan Flint, Chair of RNG and Clinical Lead Renal Dietitian Royal Free London NHS Foundation

This session was lead by Jan Flint, Chair of the RNG and aimed at non-renal  dietitians and began with  a definition …abnormal kidney function and structure. CKD often exists with other conditions such as Diabetes and CVD. Around 1.8 million have  CKD but alarmingly another million remain undiagnosed. Diabetes is the most common cause of CKD , with 1 in 3 people with  type 2 diabetes  developing CKD. Phosphate is more dangerous than potassium, with protein restriction a more controversial area in clinical practice. The underdiagnosis of  Acute Kidney Injury – AKI – was discussed with over 80,000 deaths per year attributed to this condition. RNG have a range of resources but evidence indicates low access by the profession. A suggestion for the future – an App for non renal dietitians to work out requirements for their patients.  Check out the RNG resources!

Siân O’Shea, BDA Council Member, BDA Honorary Chair

BDA Specialist DOM UK Group – Calculating energy requirements on PEN questions
Dr Angela Madden, Lecturer University of Hertfordshire and Dr Hilda Mulrooney, Senior Lecturer in Nutrition Kingston University.

Which predictive equation for resting energy expenditure is the most accurate compared to indirect calorimetry within the UK adult obese population?

What is the best predictive equation for assessing estimated energy requirement (EER) or total energy expenditure (TEE) in overweight and obese adults?

“You’ve all heard of the Mifflin equation?” was a question put to the audience as part of a session focusing on how to calculate Resting Energy Expenditure (REE) in obesity. Well I for one hadn’t, which may in part be expected working as a manager and not directly with obese patients. However, on discussion with a few people around me, it seems that one had passed them by too. I found this session fascinating and perplexing at the same time. The two speakers had obviously spent vast amounts of time trawling through the literature to find out what the best equation would be for estimating REE in obesity – their conclusion? It is best to measure REE. Why? The potential for such conflicting results when using equations may mean we are way off the mark in obtaining the right REE, with extremes at both ends, by some 1000kcals! In reality though we know we can’t measure, except in research type scenarios, so where does that leave us? Well, so far Mifflin et al 1990 seems to be the best bet – but remember, we are focusing on obesity and the project is not quite finished, so watch this space. The other aspect that was presented was Total Energy Expenditure (TEE) and PAL. My take home message from that element was:

Studies of free-living obese individuals are likely to have PAL ≥ 1.63 i.e. advised for non-obese population. If less active, consider using 1.49

Steven Grayston, BDA Council Member, Chair of Professional Practice Board


Fringe Session

Thirst for Knowledge Fringe Session

Weight Management: Balancing Diet with Physical Activity for Positive Patient Outcomes

Professor Greg Whyte, Professor of Applied Sport and Exercise Science, Liverpool Moore’s University

An engaging presentation given by Professor Greg Whyte. Key points include;

  • Small changes such as  stand up: sit down once every 30 minutes can have more impact than trying to achieve the 5 x30mins per week activity levels especially for people who are obese.
  • Energy swaps such as using stairs instead of taking the lift …sounds familiar? Nothing new here but good to touch base with basics . The importance of the energy balance equation in weight management was discussed and though information shared was not new there is more published evidence to support the value of increasing activity even at low levels.
  • ” Activity is Activity”!!

The Park Lives projects were mentioned – making activities free in local areas- to encourage any sustainable increase in activity. Last point..physical inactivity is one of the most important public health problems of the 21st century and carries same health risks for CVD as smoking.
Now.. stand up and sit down!

Siân O’Shea, BDA Council Member, BDA Honorary Chair